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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880776
Report Date: 07/09/2021
Date Signed: 07/09/2021 03:04:32 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2019 and conducted by Evaluator Stephanie Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20190919104522
FACILITY NAME:WESTMONT VILLAGEFACILITY NUMBER:
331880776
ADMINISTRATOR:FERRIS-LOCKE,PANIDAFACILITY TYPE:
740
ADDRESS:17050 ARNOLD DRIVETELEPHONE:
(858) 729-6720
CITY:RIVERSIDESTATE: CAZIP CODE:
92518
CAPACITY:225CENSUS: 116DATE:
07/09/2021
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Keith Kasin, Executive DirectorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Facility has insufficient staff to meet the resident's needs.
Facility staff failed to provide adequate food service.
Facility staff are not properly trained.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to deliver the findings of the investigation on the above allegations. The LPA identified herself and discussed the purpose of the visit with Executive Director (ED), Keith Kasin.

Regarding the allegation, "Facility has insufficient staff to meet the resident's needs," it was alleged there were not enough staff to assist with bathing/showering of residents or to clean resident bedrooms. The LPA initiated the investigation on September 26, 2019; the LPA conducted staff/resident interviews, reviewed records, and took copies of pertinent information. According to previous Executive Director (ED), Panida Ferris-Locke, the facility adopted staff from the previous facility, there are at least three staff on each shift, and not all residents require care and supervision. Resident interviews were conducted, and it was reported staffing is sufficient and available when needed. Staff interviews were inconsistent; one (1) staff reported there is a lack of staffing, while the remainder reported there was no lack of staffing. Therefore, due to a lack of information, this allegation is deemed UNSUBSTANTIATED at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 18-AS-20190919104522
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WESTMONT VILLAGE
FACILITY NUMBER: 331880776
VISIT DATE: 07/09/2021
NARRATIVE
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Pertaining to the allegation, "Facility staff failed to provide adequate food service," it was alleged the food provided to residents in care is served cold. Resident interviews were conducted; there were no reports received about meals, which should be hot/warm, being served cold. Staff interviews were inconsistent; one (1) staff reported meals are served cold, while the remainder of staff interviewed reported meals are not served cold. Therefore, due to lack of information, this allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation, "Facility staff are not properly trained," it was alleged facility staff have not completed training on the following: elder abuse training, sexual harassment, universal precautions, and training on how to treat dementia patients. The LPA audited the records of ten (10) percent of the staff employed by the facility. The records review revealed no proof of Universal Precautions and Dementia training for Staff One (S1), Two (S2), Three (S3), Four (S4), Five (S5), Six (S6), Seven (S7), Eight (S8), Nine (S9). According to previous ED Ferris-Locke, the staff training documentation is from the previous Licensee and was verified by their human resource office, as well as by a third-party audit company. Staff interviews reported training may have been provided by the previous facility, however, proper documentation was not received. Therefore, due to lack of proper record keeping, this allegation is deemed UNSUBSTANTIATED at this time.

A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with ED Kasin, in which this report was reviewed, and a copy was provided via email.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2019 and conducted by Evaluator Stephanie Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20190919104522

FACILITY NAME:WESTMONT VILLAGEFACILITY NUMBER:
331880776
ADMINISTRATOR:FERRIS-LOCKE,PANIDAFACILITY TYPE:
740
ADDRESS:17050 ARNOLD DRIVETELEPHONE:
(858) 729-6720
CITY:RIVERSIDESTATE: CAZIP CODE:
92518
CAPACITY:225CENSUS: 116DATE:
07/09/2021
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Keith Kasin, Executive DirectorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
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9
Facility does not provide activities.
INVESTIGATION FINDINGS:
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13
 Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to deliver the findings of the investigation on the above allegation. The LPA identified herself and discussed the purpose of the visit with Executive Director (ED), Keith Kasin.
Regarding the allegation, "Facility does not provide activities," it was alleged there are no activities for residents at the facility resulting in them sitting all day. The LPA initiated the investigation on September 26, 2019; the LPA conducted staff/resident interviews, reviewed records, and took copies of pertinent information. Previous Executive Director (ED), Panida Ferris-Locke, denied the allegation, explaining staff post activity notices on resident's doors and provide television commercials which broadcasts facility activities onto resident televisions. Resident interviews reported activities are available at the facility, though residents may not want to participate. In addition, the LPA observed activity notices on resident doors and an activity calendar posted. Therefore, this allegation is deemed UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. This report was reviewed with Kasin and a copy provided via email.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3